| 1. |
- Blomgren Mannerheim, Ann, et al.
(författare)
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Parents’ experiences of caring responsibility for their adult child with schizophrenia
- 2016
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Ingår i: Schizophrenia Research and Treatment. - : Hindawi Limited. - 2090-2085 .- 2090-2093.
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Tidskriftsartikel (refereegranskat)abstract
- As a consequence of the latest psychiatry-related reform in Sweden and its implementation, relatives and family members have taken over from the formal healthcare system significant responsibility for the care of persons with a mental disability and illness. The aim of this study was to systematically describe and analyze the experiences of parents' informal care responsibility. The questions were, what are the experiences around parents' informal care activities and responsibilities and how do parents construct and manage their caring responsibility and with what consequences? Semistructured in-depth interviews were conducted (16 hours of recorded material) with eight parents who were all members of the Interest Association for Schizophrenia (Intresseforeningen for Schizofreni (IFS)) in Sweden. A mixed hermeneutic deductive and inductive method was used for the interpretation of the material. The parents endow their informal caring responsibility with meaning of being a good, responsible, and accountable parent with respect to their social context and social relationships as well as with respect to the psychiatric care representatives. In this tense situation, parents compromise between elements of struggle, cooperation, avoidance, and adaption in their interaction with the world outside, meaning the world beyond the care provision for their child, as well as with the world inside themselves.
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| 2. |
- Farrell, Carole, et al.
(författare)
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Communication patterns in nurse-led chemotherapy clinics : A mixed-method study
- 2020
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 103:8, s. 1538-1545
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine patterns of nurse-patient communication in fulfilling patients' informational/psychosocial needs, effects of longer consultation/operational aspects on person-centred care experiences.METHODS: Mixed-method design; secondary analysis of transcripts of nurse-patient communication within nurse-led chemotherapy clinics in UK [3]. Purposive sampling (13 nurses); non-participant observations (61 consultations). Qualitative content analysis of audio-recorded transcripts. Quantitative analysis using the Medical Interview Aural Rating Scale [14] to compare mean differences in the number of cues and level of responding using one-way ANOVA, and correlational analyses of discursive spaces.RESULTS: Nurses responded positively to informational cues, but not psychosocial cues. Longer consultations associated with more informational and psychosocial cues (p < .0001), but not nurses' cue-responding behaviours. Four main themes emerged: challenges/opportunities for person-centred communication in biomedical contexts; patients' "life world" versus the "medical world"; three-way communication: nurse, patient and family; implications of continuity of care.CONCLUSIONS: The challenges/opportunities for cue-responding in nurse-led chemotherapy clinics were evident for informational and psychosocial support of patients. Shifting from a biomedical to biopsychosocial focus is difficult.PRACTICE IMPLICATIONS: Further evaluation is needed to integrate biopsychosocial elements into communication education/training. Careful planning is required to ensure continuity and effective use of time for person-centred care.
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| 3. |
- Hedegaard, Joel, et al.
(författare)
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Communicative construction of native versus non-native Swedish speaking patients in consultation settings
- 2013
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Ingår i: Offentlig Förvaltning. Scandinavian Journal of Public Administration. - 2000-8058 .- 2001-3310. ; 17:4, s. 21-49
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we examine patient-centered care through analyzing communicative constructions of patients, on the basis of their native language, in consultations with physicians. Whereas patient-centered care is of current interest in health care, research has not addressed its implications in this dimension. Previous studies indicate that non-native Swedish speaking patients, experience substandard interpersonal treatment far more than native Swedish speaking patients. Our findings show that the non-native Swedish speaking patients presented themselves as participating, whereas the native Swedish speaking patients presented themselves as amenable. The physicians responded in two different ways, argumentatively towards the non-native Swedish speaking patients and acknowledging vis-à-vis the native Swedish speaking patients. When decisions and conclusions were made by the patients and physicians, this resulted in preservation of the status quo in the consultations with the non-native Swedish speaking patients, while the corresponding result with the native Swedish speaking patients was monitoring of their health status. So, whereas the non-native Swedish speaking patients actually were model patient-centered care patients, physicians were more amenable towards the native Swedish speaking patients. We suggest that patient-centered care is desirable, but its practical application must be more thoroughly scrutinized from both a patient and a health care worker perspective.
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| 4. |
- Hedegaard, Joel, et al.
(författare)
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Communicative Construction of Native versus Non-Native Swedish Speaking Patients in Consultation Settings
- 2014
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Ingår i: Scandinavian Journal of Public Administration. - 2001-7405. ; 17:4, s. 21-47
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we examine patient-centered care through analyzing communicative constructions of patients, on the basis of their native language, in consultations with physicians. Whereas patient-centered care is of current interest in health care, research has not addressed its implications in this dimension. Previous studies indicate that non-native Swedish speaking patients, experience substandard interpersonal treatment far more than native Swedish speaking patients. Our findings show that the non-native Swedish speaking patients presented themselves as participating, whereas the native Swedish speaking patients presented themselves as amenable. The physicians responded in two different ways, argumentatively towards the non-native Swedish speaking patients and acknowledging vis-à-vis the native Swedish speaking patients. When decisions and conclusions were made by the patients and physicians, this resulted in preservation of the status quo in the consultations with the non-native Swedish speaking patients, while the corresponding result with the native Swedish speaking patients was monitoring of their health status. So, whereas the non-native Swedish speaking patients actually were model patient-centered care patients, physicians were more amenable towards the native Swedish speaking patients. We suggest that patient-centered care is desirable, but its practical application must be more thoroughly scrutinized from both a patient and a health care worker perspective.
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| 5. |
- Hedegaard, Joel, et al.
(författare)
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Gendered communicative construction of patients in consultation settings
- 2014
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Ingår i: Women & health. - : Informa UK Limited. - 0363-0242 .- 1541-0331. ; 54:6, s. 513-529
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to explore the communication in consultations between patients and health care staff from a gender perspective. We used 23 tape-recorded consultations between patients with Atrial Fibrillation and 5 nurses and 5 physicians at cardiac outpatient clinics at 6 different hospitals in southern Sweden during autumn 2009 to explore the verbal gendered constructions of patients. Through critical discourse analysis, we revealed that the male patients tended to describe their ailments with performance-oriented statements, whereas the female patients usually used emotional-oriented statements. The staff downplayed the male patients' questions and statements, while they acknowledged concern toward the female patients. Both the patients and the staff made conclusions according to a mutual construction. Male patients were constructed as competent, and female patients as fragile through gender-stereotypical communication. Open-ended statements and questions enabled consultations to be less limited by gender stereotypes.
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| 6. |
- Hellström Muhli, Ulla, et al.
(författare)
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How Multiple Modes of Interaction Affect Patients and Clinicians: Participation, Authority, and Understanding in a Geriatric Medical Consultation
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To extend the theoretical and empirical understanding of the interactional construction of authority and participation in geriatric medical and care consultations. To identify information resources and patterns of patient – clinician interaction that support geriatric patients’ understandings of and decisions about their health care treatments.Methods: This article is a case study from a research project entitled- Consultation encounters at a geriatric clinic – A study of communicative praxis. The larger project included forty (N=40) clinical consultations involving twenty-three patients, aged 65–90, and thirty-three clinicians (some consultations included two or more clinicians). The consultations at a Swedish university hospital were video recorded, and an interview with each patient was audio recorded subsequent to her or his consultation(s). Ten of the clinicians who participated in the recorded consultations volunteered to be recorded individually viewing and discussing their respective consultations. The case analyzed here involves consultation interaction between a patient and a pharmacist regarding the patient’s use of an inhaler, a device used to take medication at home. The recorded data are examined using methods developed to analyze interaction, conversation, and discourse. Findings: The data analysis shows how a combination of verbal, visual, tactile, and embodied information contributes to a patient’s participation and authority during a consultation. The various types of information support patterns of interaction that contribute both to the patient’s understanding of information presented by the pharmacist and to the pharmacist’s assessment of the patient’s understanding of information presented by the patient. The data analysis also explicates the components of consultation interaction that address key concerns of the pharmacist and patient. For the pharmacist, those concerns include presenting and assessing the patient’s understanding of information about using an inhaler to deliver medication.Conclusions: Interaction involving verbal, visual, embodied, and tactile activities supports patient participation and authority during clinical consultations in ways that provide the patient with information, which clarifies the clinician’s initial explanation. Such interaction also provides the clinician with unelicited information about the patient’s physical capabilities and living situation that are relevant to use of the inhaler and other prescribed treatments.Practice implications: Providing multiple modes of information in consultations supports patterns of interaction that express information beyond that initially offered by a clinician. Patients can apply such information to understandings of medical treatment and decision options concerning that treatment. This case provides an example of aspects of a type of patient-clinician interaction that can be more widely applied to increase geriatric patients’ authority and participation in their healthcare.
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| 7. |
- Hellström Muhli, Ulla, et al.
(författare)
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Patient-Involvement in Consultation for Atrial-Fibrillation : The Cardiologists’ Perspective
- 2019
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald Group Publishing Limited. - 0952-6862 .- 1758-6542. ; 32:4, s. 765-776
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose was to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: (i) how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and (ii) how cardiologists describe their familiarity with shared decision-making.Design/Methodology/Approach: A descriptive study was designed. Ten (n=10) interviews with cardiologists at four Swedish hospitals were held and a qualitative content analysis was performed on the collected data.Findings: The analysis shows cardiologists´ accounts of (i) persuasive practice, (ii) protective practice, (iii) professional role, and (iv) medical craftsmanship when it comes to patient involvement and shared decision-making.Conclusions: - The term “shared decision-making” implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. - In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed.Practical implications: Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement.Originality/value: Theoretically, we have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.
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| 8. |
- Hellström Muhli, Ulla, et al.
(författare)
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Patient Participation, Authority, and Understanding : – A Case Study of Communication Patterns in a Geriatric Consultation when using a Medical Device
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The object is to examine communication patterns in the discourse that emerges between a female geriatric patient and a pharmacist in the context of using an inhaler. This analysis is done in order to understand what clinicians (pharmacist) and a geriatric patient’ do when they construct institutional communication as a practice and how they do it in ways that support understanding medical information.Methods: This article is a qualitative case study from a project that video recorded forty (N=40) clinical consultations. The actual case was selected out since it is representative for use of material and visual information resources, applied by a pharmacist.Results: Benefits of the teach-back approach for a patient’s understanding of clinician advice are not based simply on the patient reinforcing behavior by repeating the clinician’s demonstration. Rather, the way that the patient’s discussion and manipulation of the inhaler produces a communication pattern that mitigates clinician control of topics and forms of expression.Conclusion: By combining verbal, visual and tactile actions, patients can join in consultations in a way that enhances their participation, authority and understanding.Practice implications: Many consultations can incorporate elder patients’ use of various information resources to improve their participation in treatment decisions.
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| 9. |
- Hellström Muhli, Ulla, et al.
(författare)
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Patient participation, authority and understanding : A case study of communication patterns in a geriatric consultation
- 2015
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Ingår i: Journal of Applied Linguistics and Professional Practice. - Sheffield (UK) : Equinox Publishing. - 2040-3658 .- 2040-3666. ; 12:3, s. 336-353
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The objective is to examine communication patterns in the discourse that emerges between a female geriatric patient and a pharmacist in the context of using an inhaler. This analysis is done in order to understand the communicative components of consultation interaction that support the patient learning and demonstrating understanding of medical information.Methods: This article is a qualitative case study from a project that video recorded forty (N=40) clinical consultations. The actual case was selected as a representative example of the use of material and visual information resources during a clinical consultation between a patient and a pharmacist in a geriatric setting.Results: The patient’s understanding of the clinician’s medical advice did not result simply from repeating the clinician’s demonstration. Rather, the patient’s discussion and manipulation of the inhaler produced a communication pattern that increased the patient’s authority over topics and forms of expression.Conclusion: A combination of verbal, visual and tactile activities oriented to visual and material information resources, produced pattterns of interaction that enhanced the patient’s participation, authority and understanding of medical information.Practice implications: Many consultations can incorporate elder patients’ use of various visual and material information resources to improve their participation in treatment decisions.
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| 10. |
- Krook, Maura, et al.
(författare)
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The discharge process : From a patient's perspective
- 2020
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Ingår i: Sage Open Nursing. - : SAGE Publications. - 2377-9608. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Inadequacy in discharge planning, preparation of readiness, and unplanned readmissions are closely linked and could cause misutilization of hospital services, creating higher costs to the health-care system. The information given before discharge is vital and of great importance for the well-being of the patient. The study's objective was to describe the patient's experience of their discharge process. A descriptive study was designed. Fifteen (n = 15) interviews with patients at one University Swedish hospital were held, and a qualitative content analysis was made from the collected data. The results show that accessibility, information, communication, confidence, and participation are pivotal in future development in the discharge process. The findings of this study indicate that in affirmation with the patient's experiences and desires, there is a great urgency for improvement in the discharge process. There is a need to focus on information and communication at discharge by initiating interaction from the nurses together with the doctors at a specific time in the discharge process. The discharge process needs to be more individualized and person-centered which could lead to better patient governance. Both accessibility and continuity need to be improved. The information given needs to be met with the patient's level of understanding.
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